Bosio M
Paediatric Department, Magenta Hospital and Advanced School of Paediatric Ultrasonography (S.I.U.M.B.), Via al donatore di sangue, 50, I-20013 Magenta (Milano), Italy.
Pediatr Radiol. 1998 Apr;28(4):250-5. doi: 10.1007/s002470050343.
Conventionally, vesicoureteric reflux (VUR) is assessed by fluoroscopic micturating cystourethrography (MCU) or direct or indirect radionuclide cystography (RNC). There is preliminary experience with contrast-enhanced sonography for the detection of VUR.
To evaluate the usefulness of contrast-enhanced ultrasonography using galactose suspension as an echogenic contrast medium.
In this study a galactose suspension was instilled into the bladder in 58 neonates, infants and children along with normal saline to detect the presence and the severity of VUR through the enhanced US signal. The results were compared with those of MCU and RNC. One ml/kg of echocontrast in the neonatal age group, and 0.5 ml/kg thereafter, were slowly instilled through a 4-F catheter after preliminary supine and prone urinary tract US. Indications for the investigation were antenatally diagnosed pyelectasis (21 cases) and pyelonephritis (37 cases). In 38 patients echocontrast cystosonography (ECS) was performed before, and in 20 patients after, MCU or RNC.
ECS detected 76 refluxing units in 50 patients. In eight patients, no VUR was shown, and none of these developed a urinary tract infection in 18 months of follow-up. In 43 patients, MCU or RNC detected 62 refluxing units, while in 15 no VUR was shown. Taking MCU as the gold standard and using the same grading scale, the sensitivity of ECS was 100 %. No side effects were observed. Several urinary tract abnormalities were detected by ECS. The male urethra was studied by ECS, both by retrograde infusion and during micturition.
ECS is a promising imaging technique for detecting and grading VUR without exposing patients to ionising radiation.
传统上，膀胱输尿管反流（VUR）通过荧光透视排尿膀胱尿道造影（MCU）或直接或间接放射性核素膀胱造影（RNC）进行评估。对于VUR的检测，对比增强超声检查已有初步经验。
评估使用半乳糖悬液作为回声造影剂的对比增强超声检查的效用。
本研究中，向58例新生儿、婴儿和儿童的膀胱内注入半乳糖悬液及生理盐水，通过增强的超声信号检测VUR的存在及严重程度。将结果与MCU和RNC的结果进行比较。在仰卧位和俯卧位泌尿系统超声检查后，经4F导管缓慢注入，新生儿年龄组注入1ml/kg超声造影剂，之后注入0.5ml/kg。研究指征为产前诊断的肾盂积水（21例）和肾盂肾炎（37例）。38例患者在MCU或RNC之前进行了超声造影膀胱超声检查（ECS），20例患者在之后进行了检查。
ECS在50例患者中检测到76个反流单位。8例患者未显示VUR，在18个月的随访中这些患者均未发生尿路感染。43例患者中，MCU或RNC检测到62个反流单位，15例未显示VUR。以MCU作为金标准并使用相同的分级标准，ECS的敏感性为100%。未观察到副作用。ECS检测到了几种泌尿系统异常。通过逆行注入和排尿时ECS对男性尿道进行了研究。
ECS是一种有前景的成像技术，可用于检测VUR并对其进行分级，且无需让患者暴露于电离辐射。
